Provider Demographics
NPI:1962565929
Name:DORRITIE, SHIRLEY STRATTON (MA)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:STRATTON
Last Name:DORRITIE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:KNIGHTSEN
Mailing Address - State:CA
Mailing Address - Zip Code:94548-0086
Mailing Address - Country:US
Mailing Address - Phone:925-813-0856
Mailing Address - Fax:
Practice Address - Street 1:815 1ST ST STE 3
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1165
Practice Address - Country:US
Practice Address - Phone:925-813-0856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41061106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist